Epidemiology and Infection

Research Article

Enteroaggregative Escherichia coli associated with an outbreak of diarrhoea in a neonatal nursery ward

M. Čobeljića1, B. Miljković-Selimovića2, D. Paunović-Todosijevića2, Z. Veličkovića2, Z. Lepšanovića1, N. Zeca1, D. Savića3, R. Ilića3, S. Konstantinovića3, B. Jovanovića3 and V. Kostića3

a1 Institute of Preventive Medicine, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia, Yugoslavia

a2 Public Health Centre, Niš, Serbia, Yugoslavia

a3 University Clinic Centre, Niš, Serbia, Yugoslavia


Over a 9-day period in February 1995, 16 newborn babies (age range 2–11 days) and 3 infants (24, 47 and 180 days of age) in a neonatal nursery ward developed diarrhoea accompanied by pyrexia and weight loss. Known enteropathogens were not detected in their stools but Escherichia coli displaying aggregative adherence to HEp-2 cells (enteroaggregative E. coli) were found in 12 (63%) ill infants and in none of 5 well neonates (P = 0·02). The illness lasted 3–9 days (mean 5·2) in 16 babies, whereas in 3 neonates it showed a protracted course of 18–20 days. The source of infection and the mode of transmission remained unclear. The outbreak isolates manifested properties common in this new group of diarrhoeagenic E. coli: mannose-resistant haemagglutination, haemolysis on blood agar, and clump formation in liquid culture medium. They belonged to the O4 E. coli serogroup and expressed multiple antibiotic resistance.

(Accepted March 05 1996)